Provider Demographics
NPI:1376121129
Name:ORTHOCARE ORAL SURGERY
Entity Type:Organization
Organization Name:ORTHOCARE ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FORD
Authorized Official - Middle Name:SAWYER
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-509-4999
Mailing Address - Street 1:9320 CENTER LAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0767
Mailing Address - Country:US
Mailing Address - Phone:704-509-4999
Mailing Address - Fax:704-509-4961
Practice Address - Street 1:9320 CENTER LAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0767
Practice Address - Country:US
Practice Address - Phone:704-509-4999
Practice Address - Fax:704-509-4961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty